Tsui JI.JAMA Intern Med. 2014;174:1974-1981.December 26, 2014Young adult injection drug users showed a decreased incidence rate for hepatitis C virus infection after undergoing maintenance opioid agonist treatment, according to study data.Researchers, includingJudith I. Tsui, MD, MPH, of the department of medicine at Boston University School of Medicine, conducted an observational cohort study with 552 injection drug users from San Francisco negative for anti-HCV antibody or HCV RNA between 2000 and August 2013. All of the patients were younger than 30 years and underwentHCVtesting and reported any substance use treatment every 3 months. Options for treatment for substance use reported by the patients included non-opioid agonist methods, opioid agonist methods, detoxification or maintenance therapy, or no treatment at all.During observation (680 person-years), 171 cases of HCV occurred per 100 person-years, indicating an incidence rate of 25.1 per 100 person-years. The incidence rate for HCV was lower in patients who underwent recent maintenanceopioidagonist therapy (0.31; 95% CI, 0.14-0.65) compared with patients who underwent non-opioid agonist therapy (0.63; 95% CI, 0.37-1.08), opioid agonist detoxification (1.45; 95% CI, 0.8-2.69) and no treatment.Sensitivity analysis showed a lower incidence of HCV in patients who underwent opioid agonist therapy compared with patients receiving no treatment (RR=0.37; 95% CI, 0.14-1.02). However, HCV incidence was not lower in patients who underwent opioid agonistdetoxification(RR=1.77; 95% CI, 0.95-3.32). “Our results suggest that treatment for opioid use disorders with maintenance opioid agonist therapy can reduce transmission of HCV in young adult injection drug users and should be offered as an important component of comprehensive strategies for prevention of primary HCV infection,” the researchers concluded.Disclosure:The study was funded through multiple grants from the National Institutes of Health.

My name is Ronni Marks, and I was first diagnosed with Hepatitis C (HCV) in 1997. Before people began to talk about things like “comparative effectiveness” or “patient-centeredness,” patients like me were just focused on where to go for help. Treatment options back then were painful, protracted, and unpredictable. And while my friends and family tried to support me as best they could, they didn’t understand the enormity of what HCV was or what I was experiencing. At that time, the Internet was new, and there were no HCV support groups. Now, almost twenty years later, we can finally see a light at the end of the tunnel. Since I was diagnosed, I’ve dedicated my life to creating communities for HCV patients to reach out to others facing the same challenges that they’re struggling with. And scientists have finally discovered a cure that promises manageable treatment time and limited side effects. But even though I know we’ve come a long way in improving the lives of some individuals with HCV, many patients still can’t access the drugs, and others are left with staggering medical bills.When I was first diagnosed with HCV—the leading cause of liver cancer and liver transplants—I’d already had several operations since I was an infant and had received numerous blood transfusions. My doctor suggested an aggressive treatment regimen, and I injected interferon seven days a week. But the side effects were horrendous, and I had minimal support. When I started to search for information, I realized that there was very little. After being on treatment for ten months—unsuccessful, and still quite sick—I stopped. And that’s when I made a promise to myself that I would never let anyone go through this experience alone.Shortly after I stopped treatment, I joined one of the first-ever HCV support groups where I lived, and was relieved to finally meet people who understood what I was experiencing. The American Liver Foundation (ALF) had no chapter in New York, so I volunteered to educate the community through seminars, walks, and other community events. I became a patient advocate traveling to Washington, Albany, and to the NY City Council to speak about the importance of addressing the HCV epidemic. And in 2000, I started an HCV support group at NYU/Langone Medical Center.In 2010, I took my passion for helping other HCV patients one step further, starting my own nonprofit organization to address the lack of support for people living with Hepatitis C. The Hepatitis C Mentor and Support Group (HCMSG) was founded to provide resources, training, and services free of charge to HCV patients, individuals co-infected with HIV/AIDS, and patients in need of liver transplants. And I’m proud that many hospitals, organizations, and substance use clinics have signed on to assist in providing these services. Since I became involved as a patient advocate, it’s truly remarkable how much progress has been made in the treatment of HCV. There is a whole new generation of drugs that promises a cure for most patients – drugs with a shorter treatment time and fewer side effects. Six months ago, I was one of the fortunate ones to access these new treatments, and I can barely articulate the joy in saying that the virus is no longer detected in my body. Until you clear this virus, one has no idea of how much it has impacted their whole being; my cognitive skills have vastly improved and I have significantly more energy. After living with the virus for twenty or thirty years, it’s awakening to realize what ‘normal’ is really supposed to feel like!While the cure for HCV should mark an incredible moment of rejoicing among the HCV community, because of the high cost of these drugs, we are seeing severe restrictions put on who gets access. Instead of focusing on the life-long benefits of treatment, access is being limited under the guise of short-term cost-savings. But as a matter of fact, living without the burden of the Hepatitis C virus, I hope to forego tens of thousands of dollars in future treatment while living a more productive and fulfilling life. Although short-term savings may be a shiny object to those whose chief objective is to contain medical costs, a holistic approach to treatment is the only option for the patients whose lives depend on it. To build a truly patient-centered healthcare system, we must all become effective advocates and make our voices heard, as decisions made now on who “deserves” to be treated will set a precedent for cures discovered in the future. Regardless of race, gender, orientation, or economic status, patients from all walks of life are entitled to testing, diagnosis, linkage to care and supportive services. You must be your own health advocate… and for those who can’t, some of us need to speak even louder.

PIPC | Partnership to Improve Patient Care The Partnership to Improve Patient Care exists to ensure that comparative clinical ﻿﻿effectiveness research is focused on giving providers and patients the ...http://www.pipcpatients.org/about.php